Provider Demographics
NPI:1407048135
Name:AZAM, MUHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:
Last Name:AZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RIDGE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-3300
Mailing Address - Country:US
Mailing Address - Phone:732-329-4800
Mailing Address - Fax:732-329-0445
Practice Address - Street 1:401 RIDGE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-3300
Practice Address - Country:US
Practice Address - Phone:732-329-4800
Practice Address - Fax:732-329-0445
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08303100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine